Treatment: Tumour Risk with Mitoxantrone

Martinelli et al; For The Italian Mitoxantrone Group.
Acute myeloid leukemia in Italian patients with multiple sclerosis treated with mitoxantrone.
Neurology. 2011 Nov 9. [Epub].

OBJECTIVES: To evaluate the incidence and dose-dependency of mitoxantrone (MTX)-associated acute myelocytic leukemia (AML) in the network of Italian multiple sclerosis (MS) clinics.

METHODS: We performed a multicenter retrospective cohort study of patients treated with MTX in MS centers under the Italian national health care system between 1998 and 2008. Demographic, disease, treatment, and follow-up information were collected using hospital records.

RESULTS: Data were available for 3,220 patients (63% women) from 40 Italian centers. Follow-up (mean ± SD) was 49 ± 29 months (range 12-140 months). We observed 30 cases of AML (incidence 0.93% [95% confidence interval 0.60%-1.26%]). The mean cumulative dose was higher in patients with AML (78 vs 65 mg/m(2), p = 0.028). The median interval from the start of therapy to AML diagnosis was longer than expected at 33 months (range 13-84 months); 8 patients (27%) developed AML 4 years or more after the first MTX infusion. The rate of mortality associated with AML was 37%.
CONCLUSIONS: This higher than expected risk of AML and related mortality requires that treatment decisions must be made jointly between clinicians and patients who understand their prognosis, treatment options, and treatment-related risks. The now large exposed MS population must be monitored for haematologic abnormalities for at least 6 years from the end of therapy, to ensure the rapid actions needed for early diagnosis and treatment of AML.

“Conclusions say it all,..Stay safe!”

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  • I had Mitox 2 years ago to slow doown progression. It didn't work out the way we were hoping it would but this 'AML' thing is a concern. I have to say that other than on-ward progression, there are no other complaints. What are the signs, symptoms of AML?

  • Re: "What are the signs, symptoms of AML?"

    Typically bone marrow failure; infections, bleeding and anaemia (tired).

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